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Family Medical Care

C. Difficile Colitis (Pseudomembranous Colitis)

OVERVIEW
Clostridium dificile is a normal bacterium in the intestines that can overgrow when you take antibiotics, which kill other bacteria that normally keep C. dificile from overgrowing. The most common antibiotics associated with this disease are ampicillin, clindamycin, fluoroquinolones, and cephalosporins. The C. dificile bacteria release a toxin that causes your colon to become inflamed, leading to watery diarrhea, bloody stools, abdominal cramps, and fever. C. dificile colitis is most commonly seen in patients who are hospitalized.

RISK FACTORS AND CAUSES
Risk factors for C. dificile colitis include:
  • Hospitalization
  • Antibiotic use
  • Older age
  • Medicines that weaken immune system (ie. chemotherapy)
  • Recent surgery
  • Personal history of C. dificile colitis


SYMPTOMS
Symptoms usually develop during antibiotic use or up to 10 days after stopping use. Rarely will symptoms begin later than that. Common symptoms include:
  • Watery diarrhea 3-15 times a day
  • Abdominal cramping and pain
  • Fever
  • Blood or pus in stool
  • Nausea
  • Dehydration
  • Loss of appetite
  • Weight loss
In rare cases, there can be life-threatening complications, whose symptoms may include abdominal distention, severe lower abdominal pain, high fever >101°, and profuse diarrhea. Such a severe infection can lead to ruptured bowel, sepsis, organ failure, and rarely, death.


DIAGNOSIS
The diagnosis of C. dificile colitis is made by a stool sample analysis. You may also have a flexible sigmoidoscopy to confirm a diagnosis as well as a CT scan if your doctor is worried about complications.

TREATMENT
The single most important treatment is stopping the antibiotic that allowed the infection to develop and replacing it with one less likely to allow the further growth of C. dificile. Furthermore, a different antibiotic targeted at killing C. dificile is given, which is usually Metronidazole or Vancomycin but can be something else. Probiotics may also be given to help replace normal intestinal bacteria killed by the offending antibiotic.
If a patient is severely infected, it is important to treat with oral and IV antibiotics and fluids to maintain proper hydration. At times, surgery may be needed to remove the infected colon if medications are not enough.

PREVENTION
While it is uncommon to get the infection without taking antibiotics, it is important to maintain proper hygiene like hand-washing to help prevent catching the infection from someone who may have it. It is also important to avoid unnecessary antibiotics for mild illnesses unless prescribed by your physician. Administration of antibiotics disrupts a complex balance of diverse microorganisms that colonized gastrointestinal tract and is a key factor in the developing of Clostridium difficile colonization and disease. Most probiotics colonize the gut temporarily, producing bactericidal acids and peptides. Both lactobacilli and Saccharomyces boulardii have been shown to suppress the growth of C. difficile.

ADDITIONAL INFORMATION
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